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Biomedical subjects

Mythreyi Bhargavan

Publications and source records attributed to Mythreyi Bhargavan.

13 recordsLinked to original sources
PubMed2006

Radiologists' reading times using PACS and using films: one practice's experience.

RATIONALE AND OBJECTIVES: To measure the change in radiologists' productivity in terms of interpretation time per examination when using picture archiving and communication system (PACS) workstations in a particular private practice, Valley Radiologists, Ltd, as part of a feasibility study and subsequent business plan to implement a digital enterprise. MATERIALS AND METHODS: Time to process a series of exams was measured for 18 radiologists during an uninterrupted period of a working day. Radiologists in the practice served in multiple locations. The data were analyzed in aggregate and by modality (plain film, ultrasound, computed tomography, and magnetic resonance imaging). Average time per exam, with and without PACS, was measured for each modality. Regression analysis was used to determine the independent effect of PACS on radiologist productivity. RESULTS: The mean time to process an exam was 1.4 minutes (SE = 0.04) for plain film, 1.96 minutes (SE = 0.14) for ultrasound, 5.08 minutes (SE = 0.44) for computed tomography, and 6.83 minutes (SE = 0.31) for magnetic resonance imaging. Regression results indicate that PACS had no effect on the time taken to read a series of exams. CONCLUSIONS: When considering a PACS purchase or implementation, decrease in radiologists' time to process an examination may not be realized. In this specific practice setting, we did not find evidence that PACS workstations alone, without any other changes in workflow design, improved radiologists' interpretation time.

Database Management Systems↗
PubMed2006

What characterizes academic radiology departments that secure large amounts of external funding for research?

RATIONALE AND OBJECTIVES: We sought to identify factors associated with high levels of external research funding in order to provide departments with information that may help them increase their external research funding. MATERIALS AND METHODS: National Institutes of Health (NIH) data on grants were analyzed to identify the 72 radiology departments receiving funds for diagnostic radiology research. A survey was sent to these departments. We placed them into one of three categories according to total NIH funds to the department. The survey asked about department characteristics such as size; breakdown of full-time faculty among MDs, MD/PhDs, and PhDs; research space; equipment type; and number and types of trainees. RESULTS: Thirty-nine surveys were returned, including 20 from the 21 departments with the most NIH funding. PhDs played a larger role in the most research funding-intensive departments than in others. These departments also were more likely than others to give protected time to all MDs and to devote over 5% of clinical revenues to research, and they had a lower clinical workload per MD. NIH was the source of 70% of their research funding, The role of MD/PhDs and research space per 1000 research dollars did not vary by research intensity. CONCLUSIONS: These findings only demonstrate associations; they do not show the direction of causality. Nonetheless, they suggest what departments need to do if they wish to increase their external research funding.

Academic Medical Centers↗
PubMed2006

A portrait of breast imaging specialists and of the interpretation of mammography in the United States.

OBJECTIVE: Because of the importance of breast imaging as a radiology subspecialty and concerns about malpractice, the purpose of our study is to provide a detailed portrait of breast imaging specialists, their professional activities and practices, and information on all radiologists who interpret mammograms. MATERIALS AND METHODS: We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a large, stratified random sample survey that achieved a 63% response. Responses were weighted to make them representative of all radiologists in the United States. RESULTS: Approximately 10% of all radiologists, or 2,700-2,800 radiologists, are breast imaging specialists, but 61% of radiologists interpret mammograms, and only approximately 30% of mammograms are interpreted by breast imaging specialists. Of radiologists who reported that breast imaging was their primary specialty, only 21% took a fellowship in the field (much lower than for other subspecialties), 59% spent > or = 50% of their clinical work time in the specialty, 82% interpret > or = 2,000 mammograms annually, and only 11% (also well below other subspecialties) report that the main subspecialty society (the Society of Breast Imaging) is one of the two most important professional organizations for them. On average, breast imaging specialists, like other radiologists, report that their workload is about as heavy as desired. Their level of enjoyment of radiology does not differ significantly from average. CONCLUSION: Breast imaging appears not to be as strongly organized to raise awareness of and support for its problems as are other subspecialties. Although others find evidence of likely future problems, breast imaging specialists are not currently overworked or less satisfied in their profession than other radiologists, despite relatively low revenue generation and a particularly high risk of a malpractice lawsuit.

Biopsy, Fine-Needle↗
PubMed2005

Workload of radiologists in the United States in 2002-2003 and trends since 1991-1992.

PURPOSE: To measure the workload of radiologists in the United States in 2002-2003, variations in workload according to practice characteristics, and trends since 1991-1992. MATERIALS AND METHODS: Non-individually identified data from the American College of Radiology (ACR) 2003 Survey of Radiologists were compared with data from previous ACR surveys; all statistics were nationally representative. Workload according to individual practice characteristics, such as size, type, location, and setting, was tested for statistically significant differences from the overall average. Time trends and the independent effect on workload of practice characteristics were measured with regression analysis. Changes in average procedure complexity were calculated in physician work relative value units (RVUs) per Medicare procedure. RESULTS: In 2002-2003, the average workload per full-time equivalent (FTE) radiologist was 13,900 procedures annually (standard error of mean, 200), an increase of 8.1% since 1998-1999 (P < .05) and 25.1% since 1991-1992 (P < .01). Academic practices performed 9900 procedures per FTE radiologist, and private radiology practices performed 15,200 procedures per FTE radiologist. Within most practice categories, radiologists at the 75th percentile of workload typically performed at least 50% more procedures than radiologists at the 25th percentile. Average physician work RVUs per Medicare procedure increased by 6.2% between 1998 and 2002 and by 21.6% between 1992 and 2003, mainly because of an increase in the share of more complex techniques such as magnetic resonance imaging and computed tomography in the procedure mix. CONCLUSION: Workload per radiologist measured in procedures and RVUs increased steadily between 1991-1992 and 2002-2003. Because there is much unexplained variation, averages or medians should not be used as norms.

Data Interpretation, Statistical↗
PubMed2005

Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations.

PURPOSE: To assess the most recent available data for levels and trends in utilization of radiology procedures across populations, modalities, and geographic areas. MATERIALS AND METHODS: Aggregated claims data from Medicare enrollees for all radiology procedures and from the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of almost 25 000 Americans, for some radiology procedures, were used to calculate population-based utilization for the relevant age groups. Limited private insurer data also were obtained. All radiology utilization was measured and reported, irrespective of provider specialty. Average levels and percentiles of utilization were measured according to modality, and average annual rates of increase in utilization were compared across modalities, data sources, and regions. Rates of increase in utilization according to modality and state were compared for correlation with state characteristics and initial utilization levels. RESULTS: In 2001, 4176 diagnostic and 274 therapeutic radiology procedures were performed per 1000 Medicare non-managed care enrollees. Nearly one-half of diagnostic procedures (n=2057) involved radiography. The other half involved computed tomography (CT) (n=391), magnetic resonance (MR) imaging (n=114), ultrasonography (US) (n=921), interventional radiology (n=215), mammography (n=221), and nuclear medicine (n=249). On average, between 1998 and 2001, utilization per Medicare enrollee increased 16% per year for MR imaging and 7%-15% per year for CT, US, interventional radiology, and nuclear medicine, while that for radiography increased 1% per year. The proportion of diagnostic radiology procedures performed in ambulatory settings increased from 62% in 1992 to 68% in 2001. There was wide variation across states in utilization by Medicare enrollees. State totals for diagnostic radiology were 3038 in the 10th percentile and 4573 in the 90th percentile. In 1999, MEPS reported average utilization in ambulatory settings as follows: 64 MR imaging, 102 US, 73 mammographic, 326 radiographic, and 43 radiation therapy procedures per 1000 persons (all ages) in the U.S. population. CONCLUSION: Utilization of high-technology modalities increased rapidly, while that of radiography was relatively stagnant. Variation in utilization among states and census regions was substantial.

Data Interpretation, Statistical↗
PubMed2005

A portrait of interventional radiologists in the United States.

OBJECTIVE: In recognition of the emergence of interventional radiology as an important "new component of...radiology," the objective of our study was to provide an extensive and detailed portrait of interventional radiologists, their professional activities, and the practices in which they work. MATERIALS AND METHODS: We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that oversampled interventionalists and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compared information about interventionalists with that for other radiologists. RESULTS: Depending on the definition of who is an interventionalist, 8.5-11.5% of radiologists are interventionalists. By most definitions, only slightly under half of interventionalists spend 70% or more of their clinical work time performing interventional procedures. Interventionalists work, on average, 56-58 hr weekly, a few hours longer than other radiologists. The average interventionalist performs procedures in five of the seven categories of procedures into which we divided interventional radiology, compared with one or two categories for other radiologists. The average interventionalist performs procedures in five of the seven broad categories (such as MRI, CT, and nuclear medicine) into which we divided all of radiology, much the same breadth of practice as other subspecialists and also as nonsubspecialists. CONCLUSION: Interventionalists have become a sizable group within radiology. They are in some ways like other radiologists and in other ways different, but they do not spend as much of their time in their subspecialty as some assume and, overall, are not as different.

Humans↗
PubMed2004

Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer.

PURPOSE: To prospectively assess accuracy of mammography, clinical examination, ultrasonography (US), and magnetic resonance (MR) imaging in preoperative assessment of local extent of breast cancer. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. Results of bilateral mammography, US, and contrast-enhanced MR imaging were analyzed from 111 consecutive women with known or suspected invasive breast cancer. Results were correlated with histopathologic findings. RESULTS: Analysis included 177 malignant foci in 121 cancerous breasts, of which 89 (50%) foci were palpable. Median size of 139 invasive foci was 18 mm (range, 2-107 mm). Mammographic sensitivity decreased from 100% in fatty breasts to 45% in extremely dense breasts. Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P < .001) and 21 of 38 (55%) cases of ductal carcinoma in situ (DCIS) (P < .01). US showed higher sensitivity than did mammography for IDC, depicting 104 of 110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P < .01 for each). US showed higher sensitivity for invasive cancer than DCIS (18 of 38 [47%], P < .001). MR showed higher sensitivity than did mammography for all tumor types (P < .01) and higher sensitivity than did US for DCIS (P < .001), depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of conservation or no surgery after mammography and clinical examination in 96 breasts, additional tumor (which altered surgical approach) was present in 30. Additional tumor was depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%) at MR, though extent was now overestimated in 12 of 96 (12%) at US and 20 of 96 (21%) at MR imaging. After combined mammography, clinical examination, and US, MR depicted additional tumor in another 12 of 96 (12%) breasts and led to overestimation of extent in another six (6%); US showed no detection benefit after MR imaging. Bilateral cancer was present in 10 of 111 (9%) patients; contralateral tumor was depicted mammographically in six and with both US and MR in an additional three. One contralateral cancer was demonstrated only clinically. CONCLUSION: In nonfatty breasts, US and MR imaging were more sensitive than mammography for invasive cancer, but both MR imaging and US involved risk of overestimation of tumor extent. Combined mammography, clinical examination, and MR imaging were more sensitive than any other individual test or combination of tests.

Adipose Tissue↗
PubMed2004

Self-referred whole-body imaging: where are we now?

PURPOSE: To identify current patterns and trends of computed tomographic (CT) screening, including geographic data, services provided, facility type, and demographic characteristics. MATERIALS AND METHODS: In March 2003, self-referred body imaging (SRBI) centers were identified by using the Internet. Data involving geographic location, type of facility, services provided, and demographic characteristics were collected. The 2000 U.S. census data were used to compare center locality demographics with national patterns. Descriptive statistics, t tests, and regression analyses were used to evaluate data. Nonstatistical comparisons were made with results obtained from a previously published analysis. RESULTS: The number of SRBI centers totaled 161 (vs 88 in a comparative study in 2001), and centers were distributed across 31 states and Washington, DC (vs 21 in 2001). Racial demographics of center localities more closely resembled national averages in the current study, with equal percentages of whites (76.0% vs 77.1% nationally) and Hispanics (11.5% vs 12.5% nationally). Center localities continued to exhibit greater wealth and levels of education, as reflected by higher income per capita and median household income (P < .05), as well as by higher percentages of people with college and advanced degrees (P < .05). Heart scanning was the most commonly offered service (n = 152, 94%), followed by whole-body scanning (n = 135, 84%), lung scanning (n = 126, 78%), and virtual colonoscopy (n = 88, 55%). Centers in the West were more likely to offer whole-body and organ-specific scanning, compared with centers in other regions (P < .001 for virtual colonoscopy, P < .05 for head scanning). Hospital-based centers were less likely to offer services other than heart scanning (P < .001). CONCLUSION: Compared with results of a prior analysis, SRBI centers have increased and are distributed more widely in areas with a population that more closely resembles national norms. The increased trend to broaden services may suggest possible saturation of the preexisting market.

Colonography, Computed Tomographic↗
PubMed2004

Emergency department image interpretation services at private community hospitals.

PURPOSE: To investigate the methods used at private community hospitals for delivering emergency department (ED) image interpretation services. MATERIALS AND METHODS: The authors contacted a random national sample of 114 hospitals by telephone and administered an "ED Radiology Coverage" questionnaire. The questionnaire included queries about daytime image interpretation duties, nighttime radiology coverage arrangements, and radiologist staffing needs. Results were stratified on the basis of ED patient volumes and trauma center designation and were analyzed statistically by using multivariate and logistic regression analyses. RESULTS: Representatives of 97 EDs responded to the questionnaire. Community hospital radiologists performed daytime primary interpretation of radiographs at 39 (40%) of 97 EDs, computed tomographic (CT) scans at 91 (95%) of 96 EDs, and ultrasonographic images at 87.5 (93%) of 94 EDs. "ED-dedicated" radiologists performed this emergency radiology work in only two (2%) of 97 EDs. During the nighttime, eight (8%) of 97 EDs had no radiology coverage, 80 (82%) of 97 EDs used teleradiology services in some form, and nine (9%) of 97 EDs employed in-house, rotating "non-ED-dedicated" radiologists. Analysis of participant responses revealed that clinicians at 37 (38%) of 97 EDs were able to consult radiologists for nighttime radiography questions, and 87 (92%) of 95 EDs had nighttime CT scans read by radiologists in time for patient care decisions. Twenty-four (25%) of 97 EDs reported radiologist staffing shortages, but only one indicated that it was actively trying to recruit ED-dedicated radiologists. Results of logistic regression analysis indicated that higher ED patient volumes (P =.005) and the presence of a trauma center (P =.02) each significantly increases the probability of higher nighttime levels of radiologist coverage. CONCLUSION: There is great variation in the current provision of emergency radiology services in private community hospitals.

Academic Medical Centers↗
PubMed2002

Data from a professional society placement service as a measure of the employment market for radiation oncologists.

PURPOSE: To aid in understanding the employment market for radiation oncologists, we present annual data for 1991 to 2000 from the American College of Radiology's placement service, the Professional Bureau. This data series is twice as long as any previously available. Secondarily, we compare these data with other data on the employment market. METHODS AND MATERIALS: The trends in job listings, job seekers, and listings per seeker in the Bureau are tabulated and graphed. We calculate correlations and graph relationships between the last of these and measures of the job market calculated from annual surveys. RESULTS: Bureau data show listings per job seeker declined from 0.53 in 1991 to a nadir of 0.30 in 1995 and then recovered to 1.48 in 2000. Bureau listings and job seekers, each considered separately, show a similar pattern of job market decline and then eventual recovery to better than the 1991 situation. Bureau listings per job seeker correlate 0.895 with a survey-derived index of program directors' perceptions of the job market, but statistical significance is limited (p = 0.04), because very few years of survey data are available. CONCLUSIONS: The employment market for radiation oncologists weakened in the first half of the 1990s, as had been widely reported; we present the first systematic data showing this. Data from a professional society placement service provide useful and inexpensive information on the employment market.

Employment↗
PubMed2002

Too few radiologists?

OBJECTIVE: The purpose of our study was to model the supply and demand for diagnostic radiologists over the next 30 years under alternative scenarios. MATERIALS AND METHODS: We used responses from the American College of Radiology's 2000 Survey of Diagnostic Radiologists and Radiation Oncologists to determine the current age distribution and activity of diagnostic radiologists. The numbers entering the profession were projected using three assumptions: no change in training programs, reduction of residency to 3 years (or otherwise increasing the annual number of graduates by one third), and elimination of most fellowship programs. Demand projections assume a 5% shortage in 2001 and depend on growth rates of the population, aging, scenarios of growth of age-standardized demand, and the effect of possibly productivity-enhancing technologies such as PACS (picture archiving and communication systems). RESULTS: Only a one-third increase in annual graduates materially increases the work-force relative to current training patterns. In all cases, the growth rate of the demand for radiologists far outstrips the supply over a 30-year horizon. In the shorter term, projections of current trends point to an increasing shortage, but rapid major productivity increases could produce a surplus. CONCLUSION: Those in the field of diagnostic radiology should consider measures to mitigate the increasing shortage, while monitoring developments that might signal departures from current trends in supply and demand.

Age Distribution↗
PubMed2002

Workload of radiologists in the United States in 1998-1999 and trends since 1995-1996.

OBJECTIVE: This article measures the workload of radiologists in the United States in 1998-1999, its variation by practice characteristics, and changes since 1995-1996. MATERIALS AND METHODS: Data on procedures performed were collected from the American College of Radiology's 1999 Survey of Practices, and responses were weighted to make them representative of all radiologists in the United States. Workload measured as number of procedures per full-time equivalent diagnostic radiologist was tabulated by practice type, size, setting, and location and compared with corresponding survey results from 1995-1996. The independent effect of these factors on workload was measured using regression analysis. Changes in procedure complexity were calculated in terms of relative value units (RVUs) per procedure using Medicare files. RESULTS: In 1998-1999, the average workload per full-time equivalent diagnostic radiologist had increased 8.5% since 1995-1996 to 12,800 (standard error = 200) procedures annually, with substantial variation by group type. For example, the average workload was 9400 procedures in academic groups and 13,600 in nonacademic private radiology practices. Even in relatively homogeneous categories of practices, radiologists at the 75th percentile of workload were typically performing at least 50% more procedures than radiologists at the 25th percentile. Average RVUs per Medicare procedure increased by 4% between 1995 and 1998, mainly because of an increase in the share of more complex techniques such as MR imaging and CT in the procedure mix. CONCLUSION: The workload per radiologist measured in procedures and RVUs increased substantially between 1995-1996 and 1998-1999. Because much variation remains unexplained, averages or medians should not be used as norms.

Data Interpretation, Statistical↗